<!DOCTYPE html>
<html>
	<head>
		<meta charset="utf-8">
		<title></title>
	</head>
	<body>
			<h1>American Metric电子产品调查表</h1>
		<form action="" method="post">
			<p>
				<label for="xingming">姓名：</label>
				<input type="text" id="xingming" name="text" placeholder="输入必须是2-6为字符" required/>
			</p>	
			<p>
				购买日期：
				<select>
					<option value ="1991">1991</option>
					<option value ="1992">1992</option>
					<option value ="1993">1993</option>
					<option value ="1994">1994</option>
					<option value ="1995">1995</option>
					<option value ="1996">1996</option>
					<option value ="1997">1997</option>
					<option value ="1998">1998</option>
					<option value ="1999">1999</option>
					<option value ="2000">2000</option>
					<option value ="2001">2001</option>
					<option value ="2001">2002</option>
				</select>年
				<select>
					<option value ="1">1</option>
					<option value ="2">2</option>
					<option value ="3">3</option>
					<option value ="4">4</option>
					<option value ="5">5</option>
					<option value ="6">6</option>
					<option value ="7">7</option>
					<option value ="8">8</option>
					<option value ="9">9</option>
					<option value ="10">10</option>
					<option value ="11">11</option>
					<option value ="12">12</option>
				</select>月
				<select>
					<option value ="41">1</option>
					<option value ="42">2</option>
					<option value ="43">3</option>
					<option value ="44">4</option>
					<option value ="45">5</option>
					<option value ="46">6</option>
					<option value ="47">7</option>
					<option value ="48">8</option>
					<option value ="49">9</option>
					<option value ="410">10</option>2
					<option value ="411">11</option>
					<option value ="412">12</option>
					<option value ="13">13</option>
					<option value ="14">14</option>
					<option value ="15">15</option>
					<option value ="16">16</option>
					<option value ="17">17</option>
					<option value ="18">18</option>
					<option value ="19">19</option>
					<option value ="20">20</option>
					<option value ="21">21</option>
					<option value ="22">22</option>
					<option value ="23">23</option>
					<option value ="24">24</option>
					<option value ="25">25</option>
					<option value ="26">26</option>
					<option value ="27">27</option>
					<option value ="28">28</option>
					<option value ="29">29</option>
					<option value ="30">30</option>
					<option value ="31">31</option>
				</select>日
			</p>	
			<p>
				<label for="dianzi">电子邮箱地址：</label>
				<input type="email" id="dianzi" name="email" placeholder="www.baidu.com" required pattern/>
			</p>	
			<p>
				<label for="shouji">手机号码：</label>
				<input type="text" id="shouji" name="text" placeholder="输入必须是13|15|18|开头的11位数字" size="40"/>
			</p>
			<p>
				您是否看过我们的在线产品目录？
				<label for="yes">是</label>
				<input type="radio" name="radio" id="yes" value="yes" checked/>
				<label for="no">否</label>
				<input type="radio" name="radio" id="no" value="yes"/>
			</p>
			<p>
				如果查看过，您对那些产品有兴趣购买？（选择提供的产品）<br/>
				<input type="checkbox" id="da"/>
				<label for="da">大屏幕电视机</label>
				<input type="checkbox" id="audio"/>
				<label for="audio">音频设备</label>
				<input type="checkbox" id="shipin"/>
				<label for="shipin">视频设备</label>
				<input type="checkbox" id="xiangji"/>
				<label for="xiangji">相机</label>
			</p>
			<p>
				<textarea rows="10" cols="50">您的输入：
				</textarea>
			</p>
			<p>
				<input type="submit" value="提交"/>
				<input type="reset" value="重置" disabled/>
			</p>
		</form>
	</body>
</html>
